title: Incidence, treatment, and consequences of chemotherapy-induced febrile neutropenia in the inpatient and outpatient settings.
abstract: OBJECTIVE
  To examine the incidence, treatment, and consequences of febrile neutropenia across inpatient and outpatient care settings.
  
  
  METHODS
  Data were obtained from Humedica's National Electronic Health Record-Derived Longitudinal Patient-Level Database (2007-2010). The study population included adult patients who received myelosuppressive chemotherapy for a solid tumor or non-Hodgkin's lymphoma. For each patient, each chemotherapy regimen course and each cycle within each regimen course was characterized. Febrile neutropenia episodes were identified on a cycle-specific basis based on any of the following: (1) absolute neutrophil count <1.0 × 10(9)/L and evidence of infection or fever; (2) inpatient diagnosis of neutropenia, fever, or infection; (3) outpatient diagnosis of neutropenia and non-prophylactic antimicrobial use; or (4) mention of febrile neutropenia in physician notes. Febrile neutropenia episodes were categorized as inpatient or outpatient based on the initial setting of care (i.e. acute-care inpatient facility vs. ambulatory care facility). Febrile neutropenia consequences included hospital length of stay and mortality (inpatient cases only), as well as number of febrile neutropenia-related outpatient encounters.
  
  
  RESULTS
  Among the 2131 patients in this study, 401 experienced a total of 458 febrile neutropenia episodes. Risk of febrile neutropenia during the chemotherapy regimen course was 16.8% (95% CI: 15.3, 18.4). In cycle 1 alone, risk of febrile neutropenia was 8.1% (7.1, 9.3). Most febrile neutropenia episodes (83.2%) were initially treated in the inpatient setting; the hospital mortality rate was 8.1% (5.8, 11.1), and mean hospital length of stay was 8.4 days (7.7, 9.1). Among febrile neutropenia episodes initially treated in the outpatient setting (16.8%), the mean number of outpatient management encounters was 2.6 (2.1, 3.1), most of which were in the physician's office (69.2%) or emergency department (26.9%).
  
  
  CONCLUSIONS
  Febrile neutropenia remains a common occurrence among patients receiving myelosuppressive chemotherapy and typically results in extended hospitalization and, for many patients, death. A minority of patients are, however, treated exclusively on an outpatient basis.
authors.affiliation: Policy Analysis Inc. (PAI), Brookline, MA, USA.
authors.forename: Derek
authors.initials: D
authors.lastname: Weycker
authors.forename: Richard
authors.initials: R
authors.lastname: Barron
authors.forename: Alex
authors.initials: A
authors.lastname: Kartashov
authors.forename: Jason
authors.initials: J
authors.lastname: Legg
authors.forename: Gary H
authors.initials: GH
authors.lastname: Lyman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D064146:Chemotherapy-Induced Febrile Neutropenia / Q000150:complications / Q000453:epidemiology* / Q000628:therapy*; D015331:Cohort Studies; D015897:Comorbidity; D016208:Databases, Factual; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D015994:Incidence; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents
keywords: Febrile neutropenia; incidence; length of stay; mortality; treatment